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Gender Disparity in Paediatric Admissions—Kam-lun E Hon and Edmund AS Nelson
Original Article
Gender Disparity in Paediatric Hospital Admissions Kam-lun E Hon,1MBBS, FAAP, Edmund AS Nelson,1MBChB, FRCP, FRCPCH
Abstract Introduction: To determine the magnitude of gender difference in paediatric hospital admissions. Materials and Methods: We reviewed discharge data of general medical paediatric admissions to a university teaching hospital in Hong Kong from 1984 to 2000. Based on ICD-9 codes, 9 broad categories of disease with related sub-categories were used, namely respiratory, gastrointestinal, neurological, renal, cardiac, haematological/oncological, neonatal, miscellaneous and social. Data on patients admitted to the haematological, oncological and neonatal wards were excluded from this analysis. Results: There were 92,332 patients admitted to the general paediatric wards. The 7 leading causes for admission accounted for 62% of all admissions: gastroenteritis (14%), upper respiratory tract infections (12%), asthma/wheezy bronchitis (10%), pneumonia (10%), bronchiolitis (6%), febrile convulsions (7%) and other convulsions (4%). Across almost all categories, there was a consistent excess of males (59.1% of all admissions). The male excess was even more pronounced for urinary tract infections (72%) and nephrotic syndrome (80%). The main sub-categories without this male predominance were accidents, accidental ingestion and social admissions (50% males), failure to thrive (49% males), acyanotic congenital heart disease (48%), endocrine (42%), auto-immune conditions (30%) and attempted suicide (19%). Conclusions: Although male vulnerability to illness has long been recognised, the consistency and magnitude of these gender differentials in admissions was impressive. More vigorous exploration of the underlying mechanisms responsible for this phenomenon is warranted. Ann Acad Med Singapore 2006;35:882-8 Key words: Males, Morbidity
Introduction Gender difference in the incidence of childhood diseases has long been recognised.1-4 but the magnitude of this effect and consistency across many disease categories appears not to attract much attention or research interest. Gissler and colleagues,1 in a longitudinal follow-up of all children born in Finland in 1987, reported that boys had a 20% higher risk for a low 5-min Apgar score and 11% higher risk for being born preterm. After the perinatal period, boys were found to have a 64% higher cumulative incidence of asthma, 43% higher cumulative incidence of intellectual disability and a 22% higher incidence of mortality. These differences did not vary by social class. Many other studies highlighting gender disparities have focused on single disease categories. For instance, Beeson5 reviewed a number of autoimmune diseases, which were clearly associated with either males or females. Gender differences have been
found in both common disease such as asthma,6 and in less common conditions such as cancer.7 Hong Kong, with a population of 7 million people, has a dual public and private system for both primary and secondary healthcare. Although there are 10 government (Hospital Authority or HA) and 10 private hospitals providing general paediatric inpatients services, the HA system provides the majority of inpatient care. A household survey, conducted as part of an assessment of Hong Kong’s healthcare system, showed that for the 72 children aged 15 or under who had utilised hospital services during the past 6 months, 79% had used the HA system and 21% the private system.8 The Prince of Wales Hospital (PWH), one of Hong Kong’s 2 university teaching hospitals, is situated in the Eastern New Territories of Hong Kong. From 1984 to 1997, the Paediatric Department of PWH in Hong Kong collected standardised discharge information on all
1 Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China Address for Reprints: Dr Ellis Kam-lun Hon, Department of Paediatrics, The Chinese University of Hong Kong, 6/F, Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, SAR, People’s Republic of China. Email:
[email protected]
Annals Academy of Medicine
Gender Disparity in Paediatric Admissions—Kam-lun E Hon and Edmund AS Nelson
admissions using an in-house dBase programme. Details of this paediatric audit programme have been previously described for 1654 admissions from May 1984 to May 1985.9 From January 1997, a HA hospitalwide Clinical Management System (CMS) replaced this audit programme. The CMS captures all admissions and requires the discharging doctor to enter one or more ICD-9 diagnostic and procedure codes, information of attending medical staff, a discharge summary and the patient’s gender. The system can identify all discharges that remain uncoded and all discharge summaries that are not completed. These 2 data sources were used to investigate the magnitude of gender differences by disease category for general paediatric admissions over a 17-year period (1984-2000). Materials and Methods Epiinfo (Version 6.04c, CDC Atlanta) programming routines were used to combine and recode the PWH paediatric audit programme and the CMS data. The original PWH paediatric audit programme defined 9 broad categories of disease with related sub-categories based on ICD-9 codes: respiratory, gastrointestinal, neurological, renal, cardiac, haematological/ oncological, neonatal, miscellaneous and social (Table 1). These 9 categories and their related sub-categories were retained in the final Epiinfo record file that contained all the data from 1984 to 2000. From 1984 to 1991, data on all haematology/oncology admissions were collected but from 1992 to 1996, data on these patients were entered into a separate audit programme. Likewise, data on all neonatal admissions from 1984 to 1997 were not collected in the general paediatric audit programme. The CMS from 1997 includes data on all hospital admissions. The present analysis therefore used only the data for general paediatric admissions (0 to 15 years) and excluded admissions to the haematological, oncological and neonatal wards. Severe trauma, surgical, orthopaedic and gynaecology patients were usually managed by the respective surgical subspecialties and not included in the general paediatric admissions. Odds ratios (OR) and 95% confidence intervals (95% CIs) were compiled and P values 55% of admissions). Males were especially more likely to be admitted for lower respiratory tract problems such as asthma (OR, 1.40; 95% CI, 1.341.47; P
